头孢哌酮/舒巴坦联合阿米卡星与亚胺培南/西司他丁经验性治疗中性粒细胞缺乏发热患者的对照研究

目的研究血液肿瘤患者粒细胞缺乏出现发热时,头孢哌酮/舒巴坦联合阿米卡星与亚胺培南/西司他丁治疗的临床疗效和安全性。方法一项随机、单盲、对照的多中心研究,共纳入216例确诊为血液系统肿瘤伴中性粒细胞缺乏发热的住院患者,随机分组接受头孢哌酮/舒巴坦联合阿米卡星与亚胺培南/西司他丁治疗,对比其临床疗效、细菌学疗效与不良反应。结果两组临床有效率分别为69.05%和74.44%,经统计学处理,两组间差异无统计学意义;治疗后体温明显降低,与基线相比具差异有统计学意义(P<0.01);每日体温的变化,头孢哌酮/舒巴坦联合阿米卡星组比亚胺培南/西司他丁组更明显,平均退热时间分别为(3.09±1.81)d和(3.67±1.99)d;头孢哌酮/舒巴坦联合阿米卡星组的细菌学疗效明显优于亚胺培南/西司他丁组,头孢哌酮/舒巴坦联合阿米卡星组不良反应的发生率更低(3.97%vs10.00%),两组病例均未观察到有明显的肝、肾功能损害,亦无严重不良反应发生。结论头孢哌酮/舒巴坦联合阿米卡星可作为经验性治疗中性粒细胞缺乏伴发热的血液系统肿瘤患者的理想治疗,不良反应轻,耐受性好。     

肺癌患者肺脓肿感染病原菌分布、耐药性以及预防研究

目的 探讨肺癌患者肺脓肿感染病原菌分布、耐药性以及预防。方法 对纳入研究的68例肺癌肺脓肿感染患者的痰液进行病原体培养与药敏实验,分析其病原体分布特点与其耐药性。结果 68例感染肺脓肿肺癌患者痰液中共检出病原菌118株,其中革兰阴性菌63株(53. 39%)、革兰阳性菌41株(34. 75%)、真菌14株(11. 86%)。肺炎链球菌对氨苄西林/舒巴坦、头孢哌酮/舒巴坦、亚胺培南/西司他丁与万古霉素耐药率较低;金黄色葡萄球菌对硫酸阿米卡星、头孢哌酮/舒巴坦、亚胺培南/西司他丁与万古霉素的耐药率较低;铜绿假单胞菌对头孢哌酮/舒巴坦、硫酸阿米卡星、亚胺培南/西司他丁的耐药率较低。结论 对肺脓肿感染肺癌患者根据耐药率合理选择抗菌药物可以提升临床治疗效果。     

头孢哌酮/舒巴坦与亚胺培南/西司他丁和哌拉西林/他唑巴坦治疗革兰阴性菌感染的药物经济学评价

目的评价头孢哌酮/舒巴坦、亚胺培南/西司他丁及哌拉西林/他唑巴坦治疗革兰阴性菌感染的有效性和经济性。方法采用非随机观察性研究,选取2012年1月1日-2016年5月11日期间,使用头孢哌酮/舒巴坦、亚胺培南/西司他丁或哌拉西林/他唑巴坦进行治疗的革兰阴性菌感染住院患者322例的抗菌药物治疗数据,采用成本效果分析进行经济学评价。结果本研究数据来源于一项大样本、非随机主动监测研究课题,原始数据组间协变量存在不均衡现象,采用倾向性评分匹配后,组间协变量不均衡现象得到显著改善。匹配后以目标抗菌药物成本进行经济学分析,头孢哌酮/舒巴坦VS亚胺培南/西司他丁时,头孢哌酮/舒巴坦每获得1%临床疗效、微生物疗效、综合疗效、30d生存率仅需39.15元、51.02元、52.61元、40.09元,而亚胺培南/西司他丁则需要75.54元、81.28元、83.39元、72.15元;头孢哌酮/舒巴坦VS哌拉西林/他唑巴坦时,头孢哌酮/舒巴坦每获得1%临床疗效、微生物疗效、综合疗效、30d生存率仅需36.94元、46.80元、48.40元、33.42元,而哌拉西林/他唑巴坦则需要99.99元、117.64元、121.21元、95.23元。四种成本效果分析均显示头孢哌酮/舒巴坦具有明显的经济学优势。在同等疗效下,头孢哌酮/舒巴坦成本约是哌拉西林/他唑巴坦和亚胺培南/西司他丁的1/3-1/2。采用疗效的95%可信限进行敏感性分析,结论仍然成立。结论头孢哌酮/舒巴坦在治疗革兰阴性菌(包括多重耐药菌)感染时更具有成本效果优势。     

儿童恶性血液病患者中性粒细胞缺乏期医院感染的临床分析

目的探讨儿童恶性血液病患者中性粒细胞缺乏期医院感染发生的特点及防治对策。方法回顾性分析2000年1月-2005年6月174例儿童恶性血液病住院患者接受强化疗后在中性粒细胞缺乏期感染发生的特点、感染发生的因素及感染种类等以及治疗效果。结果儿童恶性血液病患者中性粒细胞缺乏期医院感染发生率为67.4%;以呼吸道感染最多见为45.4%,其次是口腔、血液、皮肤和肠道等;细菌感染为86.8%,真菌感染为13.2%;对革兰阴性杆菌(G-杆菌)较敏感的药物有亚胺培南/西司他丁、美罗培南、阿米卡星、头孢他啶、哌拉西林/他唑巴坦、替卡西林/克拉维酸;对革兰阴性球菌(G 球菌)敏感的药物有万古霉素,其他依次为亚胺培南/西司他丁、美罗培南、氨苄西林/舒巴坦、环丙沙星、克林霉素;医院感染致死率为44.4%。结论儿童恶性血液病患者中性粒细胞缺乏期医院感染发生率高,作好基础护理、加强肠道消毒、使用粒细胞刺激因子、合理使用抗菌药物与警惕真菌感染等是防治儿童恶性血液病患者中性粒细胞缺乏期医院感染的重要措施。     

亚胺培南/西司他丁治疗老年急性呼吸道感染疗效观察

目的 观察亚胺培南／西司他丁（泰能）用于老年危重症患者合并急性呼吸道感染的疗效及不良反应。方法 对22例感染患者每天给予亚胺增南／西司他丁1－2g，分2－3次静滴治疗进行观察。20例单用，2例加用其他抗生素，平均用药5d。结果 总有效率77.3%，且未见不良反应。结论 亚胺培南／西司他丁用于抢救急危重症感染患者疗效迅速而满意。     

亚胺培南/西司他丁在早产儿呼吸机相关性肺炎的应用

目的评价亚胺培南/西司他丁治疗早产儿呼吸机相关性肺炎(VAP)的有效性和安全性。方法回顾性分析亚胺培南/西司他丁治疗31例早产儿VAP的临床疗效和不良反应。临床疗效评价分为痊愈、显效、进步和无效。痊愈和显效者视为治疗有效病例。结果31例发生VAP的早产儿用亚胺培南/西司他丁治疗结束时,痊愈18例,显效5例,进步3例,无效5例,治疗有效率为74.19%;细菌清除率为80.00%(20/25);2例(6.45%)发生不良反应,1例为皮疹,1例为尿蛋白异常,均表现轻微,停药后消失。结论亚胺培南/西司他丁是治疗早产儿VAP的一种安全而有效的抗菌药物。     

肺癌患者合并肺脓肿感染的特点与防治研究

目的研究肺癌患者肺脓肿感染病原菌分布、耐药性以及预防,以降低感染发生。方法对2012年5月-2015年5月医院治疗的308例肺癌患者临床资料进行回顾性分析,并对45例感染肺脓肿的患者进行痰液病原菌培养以及药敏试验,对病原菌分布特点以及耐药性进行分析,提出预防治疗措施。结果肺癌合并肺脓肿患者45例,感染率为14.61%;检出病原菌分别为革兰阴性菌、革兰阳性菌及真菌,分别占53.66%、34.15%、12.19%,检出以金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌为主,分别占19.51%、23.17%、13.41%;革兰阳性菌对阿米卡星、头孢哌酮/舒巴坦、亚胺培南/西司他丁、万古霉素的耐药性较低;铜绿假单胞菌对阿米卡星、头孢哌酮/舒巴坦、妥布霉素、亚胺培南/西司他丁的耐药性较低;大肠埃希菌对亚胺培南以及亚胺培南/西司他丁具有较低的耐药性;肺炎克雷伯菌对亚胺培南/西司他丁以及米诺环素的耐药率较低。结论肺癌患者肺脓肿的感染率相对较高,应及时对患者痰液进行培养鉴别以及药敏试验,根据试验结果合理的选用抗菌药物,提高治疗效果。     

亚胺培南/西司他丁治疗血液肿瘤合并感染的疗效与分析

目的分析亚胺培南/西司他丁(泰能)治疗血液肿瘤合并感染的疗效. 方法对289例经临床确诊为血液疾患合并有明确感染的住院患者,使用亚胺培南/西司他丁治疗,治疗效果根据卫生部新药临床研究指导原则标准进行评定. 结果 289例患者中痊愈191例(66.1%);显效41例(14.6%);总有效患者为232例(80.7%). 结论应用亚胺培南/西司他丁治疗血液肿瘤合并感染的患者,具有疗效快、作用显著之特点.     

亚胺培南／西司他丁治疗90例老年人医院感染临床分析

目的 对亚胺培南／西司他丁（泰能）治疗老年人医院感染的疗效及其抗菌活性进行分析。方法 90例患者应用亚胺培南／西司他丁0．75－1．5g/ki.v,疗程2－14d。对培养出的79株细菌作药敏试验,并检测亚胺培南／西司他丁等8种药物对303株临床分离菌的抗菌活性。结果 79株细菌中G^- 菌占72．8％、G^ 菌占27．2％;亚胺培南／西司他丁治疗的总有效率为80．0％,细菌清除率为77．2％;303株临床分离菌对亚胺培南／西司他丁的敏感率为92．7％,高于其他7种抗菌药物。结论 亚胺培南／西司他丁治疗老年人医院感染具有疗效较好、副反应轻的特点,但其耐药菌株尤其是嗜麦芽黄单胞菌感染值得重视。     

亚胺培南/西司他丁预防造血干细胞移植早期感染的疗效分析

目的 探讨亚胺培南/西司他丁（泰能）预防造血干细胞移植早期感染的疗效。方法16例患者在全环境保护下,当外周血白细胞<0.5×109/L时,用亚胺培南/西司他丁0.5静滴,每日3次,3～7 d,监测患者体表及层流室内细菌分布情况,观察病情。结果 16例患者中1例在+4d（用亚胺培南/西司他丁的第1天）发生感染,感染率为 6.25％,且继续用药后感染被控制。结论 短期使用亚胺培南/西司他丁预防造血干细胞移植早期感染可获得好的效果。     

Spread of influenzaviruses A/ENGLAND/42/72 AND A/Hong Kong/1/68

Seroconversion for A/England/42/72 (H3N2) virus occurred in a child in Calcutta in August 1971, one month after the virus was first isolated in India. During the following 5 months a small increase was observed in the geometric mean titres (GMT). In mid-1972 the virus was in Kathmandu, Nepal, where the children had a higher GMT than the adults. The GMT increased sharply during 1972 and early 1973 and this increase was accompanied by an increased number of hospital admissions for respiratory diseases. Among the people in the isolated village of Lang Tang (3 500 m elevation), the GMT and prevalence for both A/England/42/72 and A/Hong Kong/1/68 (H3N2) were less than 50% of the Kathmandu values.     

Experimental infection of horses with Hendra virus/Australia/horse/2008/Redlands

Hendra virus (HeV) is a highly pathogenic zoonotic paramyxovirus harbored by Australian flying foxes with sporadic spillovers directly to horses. Although the mode and critical control points of HeV spillover to horses from flying foxes, and the risk for transmission from infected horses to other horses and humans, are poorly understood, we successfully established systemic HeV disease in 3 horses exposed to Hendra virus/Australia/Horse/2008/Redlands by the oronasal route, a plausible route for natural infection. In 2 of the 3 animals, HeV RNA was detected continually in nasal swabs from as early as 2 days postexposure, indicating that systemic spread of the virus may be preceded by local viral replication in the nasal cavity or nasopharynx. Our data suggest that a critical factor for reducing HeV exposure risk to humans includes early consideration of HeV in the differential diagnosis and institution of appropriate infection control procedures.     

Development and Implementation of A European Guideline and Training Standards for Diabetes Prevention-The IMAGE project

Background The dramatic increase of type 2 diabetes, particularly in younger people, has developed into a major public health concern of the European Union (EU). Several studies have demonstrated that prevention programmes can significantly reduce the risk of developing diabetes. At the EU level, there is a clear consensus that action is needed now to develop targeted prevention management programmes for type 2 diabetes. Currently several prevention management concepts exist in various European countries which can be implemented in clinical practice. Nevertheless, EU-wide strategies are still lacking. Therefore, initiated by the Technical University Dresden, the IMAGE project was submitted to the European Commission under the call for proposals 2006 for the programme of community action in the field of public health (2003–2008) and recommended for co-funding as one of the largest in the public health sector. Methods IMAGE stands for “Development and Implementation of A European Guideline and Training Standards for Diabetes Prevention”. Its general objective is to improve the ability of EU countries to prevent type 2 diabetes in Europe. Within the project, four specific objectives will be developed and implemented into clinical practice: (1) joint European guidelines, (2) a European curriculum for the training of prevention managers, (3) European standards for quality control of diabetes prevention programmes, and (4) a European e-health training portal for prevention managers. Results By now, 32 partners from 13 EU member states plus partners from Serbia-Montenegro, the Ukraine and Israel are involved in the project. The project duration is 3 years, starting in May 2007. The partners who are involved in the IMAGE project, building a consortium of expertise, will work in seven work packages to achieve the project’s objectives. Conclusion The development of competent education programmes, as well as the establishment of quality standards for the primary prevention of type 2 diabetes, will significantly enhance the ability of healthcare professionals to respond swiftly to the drastic increase of type 2 diabetes and its burden to society. Implementing the project achievements will be of major importance in both the prevention of diabetes and the promotion of health through addressing health determinants across all policies and activities in Europe.